Healthcare Provider Details

I. General information

NPI: 1558355628
Provider Name (Legal Business Name): EDWARD FARROW CALDWELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 CEDAR ST
HYANNIS MA
02601-3009
US

IV. Provider business mailing address

65 CEDAR ST
HYANNIS MA
02601-3009
US

V. Phone/Fax

Practice location:
  • Phone: 508-790-0611
  • Fax: 508-790-0589
Mailing address:
  • Phone: 508-790-0611
  • Fax: 508-790-0589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number59036
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License Number59036
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: